Analgesics in Dentistry
Analgesics are widely used in dentistry as “pain killers” and for their anti-inflammatory properties. These compounds are divided into two primary classifications: simple analgesics and nonsteroidal anti-inflammatory drugs (NSAIDS). Regardless of the cause, simple analgesics and NSAIDS have an effect on pain. While several common side effects exist (eg, nausea, vomiting, rashes, assorted gastrointestinal disturbances, and occasionally tinnitus), they are generally considered safe for the short-term treatment of tooth, periodontal, and musculoskeletal pain associated with dental procedures.
Analgesics by definition and usage only relieve pain. Their effect begins within minutes of administration and generally lasts for several hours. Nonsteroidal anti-inflammatory drugs are also analgesics when administered in single doses. By comparison, corticosteroids are purely anti-inflammatory and exert no analgesic effect.
Narcotics are often required by patients suffering from an acute onset of dental pain (as opposed to chronic musculoskeletal pain). Due to the potential for abuse, patient use should be limited in relation to the traumatic onset, generally restricted to treatment of only a few days. In dentistry, the most commonly used medications in this classification are the synthetic or semisynthetic opiates, eg, hydrocodone. Hydrocodone is a semisynthetic opioid analgesic that induces multiple effects in a manner similar to that of codeine. Although the mode of action is not completely understood, the areas of action for pain relief seem to relate to the existence of opiate receptors in the central nervous system (CNS). The ability to cause a direct effect on the CNS is a characteristic factor that separates the opioids from the NSAIDS and other peripheral acting analgesics.
Hydrocodone or other synthetic or semisynthetic opioids are traditionally administered in combination with aspirin, acetaminophen, and other analgesics. The clinical benefits of the ingredients are additive. The result is an analgesic effect on both the CNS and the peripheral areas of pain, resulting in acute pain control from different modes of action. This is particularly effective in dentistry, where a localized entity often provokes the onset of pain. For example, tooth extraction has both a peripheral and a CNS component. During the acute phase of the painful episode, a combination effect on both the peripheral site and the CNS would provide more efficacious pain control.
A new medication has been introduced, combining hydrocodone with ibuprofen. In dentistry, the medication has been recommended in short-term doses (less than 10 days) for acute pain situations with a dosage of one tablet every 4 to 6 hours, not to exceed five tablets per day.
Pain control is one of the most fundamental aspects of the modern dental practice. As is the case in the prescription of other drugs, the specific requirements and reactions of the patient must be taken into consideration to achieve optimal pain management. Unless there is proper pain control, optimal dental care cannot be rendered. Our skills as dentists are often judged by our ability to control the pain involved in any given procedure. It is imperative for the dental professional to understand the differences in analgesic treatment options. Many times analgesics will provide the comfort required by the patients to continue with a well established personal treatment plan. The correct use of synthetic opioids in combination with NSAIDS can provide an effective regimen for reduction of acute dental pain.